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Do No Harm? Should Patients Still Trust Their Doctors?

Medical Journals Show Increasing Support for Euthanasia

By Denise J. Hunnell, MD

WASHINGTON, D.C., AUG. 22, 2012 (Zenit.org).- Primum non nocere. First
do no
harm. This edict has been part of medical ethics since the time of the
ancient
Greek physician, Hippocrates, in the fifth century B.C. It is
found in
the Hippocratic Corpus, a collection of medical writing attributed to
Hippocrates. The original Hippocratic oath includes:

I will apply dietetic measures for the benefit of the sick according to
my
ability and judgment; I will keep them from harm and injustice.

For millennia the physician has been charged with being an advocate for
the
patient. Part of the impetus for the original Hippocratic oath was to
ensure
that doctors would not be paid by an enemy to give poison instead of
medicine.
Patients should be able to come to their doctor when they are sick and
weakened, and have no fear that their vulnerability will be
exploited.

Unfortunately, the sacred trust of the doctor-patient relationship is
being
strained by a new ethical model. Physicians are being urged to place
the
greater good above the needs of their individual patients. A disregard
for the
sanctity of human life as well as a utilitarian philosophy that judges
the
value of a patient to society is becoming more mainstream in the
medical
profession. This is evidenced by the increasing number of articles in
respected
medical journals that call for approval of assisted suicide and
euthanasia,
euphemistically called assisted dying.

The British Medical Journal (BMJ), a publication distributed to the
members of
the British Medical Association, devoted much of its June 14, 2012,
issue to
endorsing voluntary euthanasia and physician assisted suicide. Raymond
Tallis,
emeritus professor of geriatric medicine at the University of
Manchester,
argues in this issue that respect for patient desires and autonomy
renders
irrelevant any opinion on the matter by the Royal College of Physicians
or the
British Medical Association. Therefore, all opposition to euthanasia is
merely
inappropriate paternalism and should be dropped.

In this same issue, Tess McPherson relates the difficult last days of
her
mother, Ann McPherson, and uses this painful experience as a call for
legalized
physician assisted suicide and euthanasia. Rather than seeking better
pain
control, she argues that death is the best option for those suffering
at the
end of their lives.

Finally, Fiona Goodlee, editor in chief of the BMJ, rounds out the
arguments by
declaring that legalization of assisted dying is not a medical
decision, but
rather a societal question. She argues that the role of the physician
is
compatible with providing euthanasia or assisted suicide and if society
wants
it, they should get it.

Amid these scholarly endorsements of euthanasia come the claims of
British
physician Patrick Pullicino that the National Health Service (NHS) is
effectively killing 130,000 patients every year when doctors place
these
patients on the Liverpool Care Protocol (LCP) and deny them nutrition
and
hydration. According to the Daily Mail:

Professor Pullicino claimed that far too often elderly patients who
could live
longer are placed on the LCP and it had now become an 'assisted death
pathway
rather than a care pathway'.

He cited 'pressure on beds and difficulty with nursing confused or
difficult-to-manage elderly patients' as factors.

Professor Pullicino revealed he had personally intervened to take a
patient off
the LCP who went on to be successfully treated.

The medical literature from the United States also shows an increasing
acceptance of physician assisted suicide and euthanasia. The July 12,
2012,
issue of the New England Journal of Medicine (NEJM) included an article
by Dr.
Lisa Soleymani Lehmann and Julian Prokopetz that suggested physician
opposition
to assisted dying was an unreasonable barrier to patients seeking
lethal medications.
They recommended that all patients who met the legal criteria for
assisted
suicide as outlined in the state laws of Oregon, Washington, and
Montana should
be able to obtain the drugs necessary for suicide without a physician's
prescription or approval.

Perhaps the most chilling example is the enthusiastic endorsement in
the
Journal of the American Medical Association (JAMA) for the book Death,
Dying,
and Organ Transplantation: Reconstructing Medical Ethics at the End of
Life, by
Drs. Franklin Miller and Robert Truog. This book seeks to do away with
two core
principles of medical care. The first is that a physician cannot
intentionally
cause the death of his patient. The second is that donors of vital
organs for
transplantation must be dead before the organs are harvested.

Catholic health care ethics, in accordance with natural law, holds that
when
the burden of life-sustaining extraordinary care such as a ventilator
is
greater than the benefit it provides, such care can be withdrawn. This
is not
seen as causing the death of the patient, but rather allowing the
patient to
die from his underlying illness. Miller and Truog disagree and assert
that such
an act directly causes the death of the patient. They then begin their
descent
down the slippery slope by claiming that if causing death by
withdrawing
life-sustaining care is acceptable, then active voluntary euthanasia by
lethal
injection should also be acceptable. Further, if voluntary euthanasia
by
injection is acceptable, then voluntary euthanasia by removal of vital
organs
to be used for transplantation should be equally acceptable. This
radical
argument could be disregarded as fringe thinking had it not been so
prominently
and positively recommended in JAMA.

It is reasonable to say that the notion that physicians should not kill
their
patients is still widespread among medical professionals. Indeed,
several of
the aforementioned authors take their colleagues to task for opposing
euthanasia and physician assisted suicide. The growing numbers of
prestigious
medical journals that are routinely publishing support for all forms of
assisted dying are, however, a clear indication that this approach to
end of
life care is making significant inroads in mainstream medical ethics.
The
foundational principles of health care that date back to Hippocrates
are in
jeopardy.

This has serious implications for patients. No longer can a patient
assume that
his physician has his best medical interests at heart. Now physicians
are being
urged to consider the cost to society of a patient's care and judge
whether a
patient is worthy of such expense. Instead of seeking to provide
comfort and
authentic compassion at the end of life, there is increased support for
hastening death as an expedient solution to suffering.

It is now incumbent upon every patient to explore the ethical
principles of his
doctor. Does he uphold the sanctity of life from conception to natural
death?
Does he understand that treatments can be deemed burdensome, but human
life is
never burdensome? Does he view nutrition and hydration as ordinary care
as long
as a patient can derive a benefit from it? Does he reject all
justifications
for intentionally causing the death of his patients?

If your physician does not answer unequivocally yes to each of these
questions,
can you really trust him with your life?

* * *

Denise Hunnell, MD, is a Fellow of HLI America, an educational
initiative
of Human Life International. She writes for HLI America’s
Truth and
Charity Forum.